You know and love Massachusetts as the state with (near) universal health insurance coverage for all of its residents. But their novel system is break-the-bank expensive, so the state is looking to overhaul how it pays for health care. Last week Massachusetts legislators proposed to pay doctors and hospitals a “global fee” to care for every insured patient, rather than paying for each test or service performed as is done now.

This would be a radical change to the health care business and would very likely change the way doctors evaluate and treat many of their patients. Today, doctors and hospitals are paid more for ordering more tests and providing more services, regardless of whether it’s of benefit to the patient. Under a “global fee”, the incentive would be to provide less care. Will that benefit patients? It’s much too early to say.

audrey young

I'm a general internist from Seattle. My first book was What Patients Taught Me. The latest book is House of Hope and Fear, published in August 2009, and now out in paperback. For more about both books and about physician writers, please visit my website.